Quality Measures for Prenatal Care
A Comparison of Care in Six Health Care Plans
Objective: To develop a method for comparing the quality of prenatal care provided in different health care plans and making the results publicly available.
Design: Retrospective cohort study.
Setting: Six health maintenance organizations.
Patients: Random sample of all deliveries in the six managed care organizations during a 1-year interval. Patients not continuously enrolled in the managed care organization for the year prior to delivery were excluded.
Main Outcome Measure: Adherence to explicit, externally determined prenatal care process criteria that were grouped into three scales.
Results: Adherence to most of the process criteria was 75% to 80% in the six organizations. Significant differences in adherence rates among managed care organizations were found. For example, at the criterion level, rates at which cervical gonorrhea cultures were obtained at the first visit varied from 7% of patients in one plan to 96% of patients in another. The three process scales that group the individual criteria to facilitate comparisons of oveall adherence confirmed significant variations in the quality of prenatal care among the health plans. For example, scores on the 100-point scale measuring use of routine screening tests ranged from 64 to 93. These results were not affected by adjustments for differences in age, race, and parity among pregnant women enrolled in the organizations.
Conclusions: Although in general the quality of prenatal care at the six managed care organizations was quite good, there are significant variations in specific aspects of quality. This information could be useful to purchasers when they consider which plans to offer their employees.